To optimize proper positioning, make sure the mask is completely deflated, with a smooth, well-lubricated surface. Placing the mask face down on a flat surface such as a table helps achieve proper deflation.
If insertion is unsuccessful with cricoid pressure, release pressure and reattempt insertion.
If the initial laryngeal mask airway (LMA) placed does not result in a good seal, attempt the next larger size. In general, if a patient is between sizes, choose the larger size.
When intubating through the ILMA, advance the endotracheal tube (ETT) until it is about to emerge from the LMA (near the 15-cm mark). Then, lift up on the handle as the ETT is advanced into the trachea to complete intubation. This is known as the Verghese maneuver after Dr. Chandy Verghese.
Although the LMA can be left in place after intubation, removing it promptly helps minimize upper airway trauma.